MEDICARE: DELLA WAGNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	MPSS-EFJIQV	CA

General Provider Information

NPI Number	:	1124552997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELLA WAGNER

Provider Business Mailing Address
First Line	:	301 E COOK ST STE B
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5133
Country	:	US
Telephone Number	:	805-608-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 E COOK ST STE B
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5133
Country	:	US
Telephone Number	:	805-608-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	10/24/2025

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